Subcutaneous emphysema as a complication of measles: A case series of nine pediatric patients from Ethiopia.

Subcutaneous emphysema is an uncommon complication of measles with potentially serious consequences. This case series describes nine pediatric patients who developed subcutaneous emphysema during a measles outbreak at Bachuma Primary Hospital in rural Ethiopia between October and December 2023. Among 589 children admitted with complicated measles, nine developed subcutaneous emphysema, corresponding to an incidence of 1.52%, at the higher end of previously reported outbreak ranges. All patients were unvaccinated, with a median age of 24 months. Five children had acute malnutrition, including three with severe acute malnutrition and two with moderate acute malnutrition, and eight had clinical signs of micronutrient deficiency. Subcutaneous emphysema manifested a median of 4 days after rash onset, often after initiation of humidified nasal oxygen at 2-6 L/min. Management included supportive care, vitamin A, antibiotics when clinically indicated, nutritional rehabilitation, close monitoring, and emergency decompression when pneumothorax was suspected. Five patients were transferred to a regional hospital; four recovered and one died within 48 h after transfer from hypoxemic respiratory failure. This series highlights the importance of vigilance for air-leak complications in children with severe measles pneumonia, malnutrition, and oxygen requirement in resource-limited outbreak settings.